Pediatric Persistent Depressive Disorder (Dysthymia) Workup

Updated: Oct 14, 2016
  • Author: Jeffrey S Forrest, MD; Chief Editor: Caroly Pataki, MD  more...
  • Print
Workup

Approach Considerations

Screening

The American Academy of Child and Adolescent Psychiatry (AACAP) recommends screening of children and adolescents for depressive symptoms; specifically, sad mood, irritability, and anhedonia. If these symptoms are present most of the time, affect the child's psychosocial functioning, or are greater than the expected level for the child's developmental stage, then further evaluation for the presence of depression should be undertaken.

Lab studies

Perform laboratory studies in patients with persistent depressive disorder (PDD) only when the history and physical examination suggest their relevance.

Imaging studies

Few, if any, studies use either structural (ie, computed tomography [CT] scanning, magnetic resonance imaging [MRI]) or functional (ie, positron emission tomography [PET] scanning, single-photon emission CT [SPECT] scanning, magnetic resonance spectroscopy [MRS]) in the diagnosis of dysthymia in pediatric patients.

Next:

Mental Health Evaluation

Assessment of PDD in children can be accomplished in several ways. The AACAP recommends a comprehensive mental health diagnostic evaluation as the single most useful tool in the diagnosis of depressive disorders.

Standardized diagnostic interviews, conducted by clinicians or lay examiners, are often used in research settings and have been psychometrically studied. Self-report questionnaires have been developed but serve mainly as screening tools and may not reflect diagnostic criteria for PDD. Likewise, ratings by teachers, parents, and peers may be helpful as part of the overall assessment of the depressed pediatric patient but, of course, are not sufficient to make a diagnostic determination.

According to the AACAP, a comprehensive mental health diagnostic evaluation consists of separate or conjoint interviews by a trained clinician with the patient and his or her parents or caregivers. Contact with other informants (eg, teachers, primary care physicians) is helpful. A mental status examination, modified as necessary for the patient's developmental age, should be part of the assessment.

Physical examination and, as noted above, laboratory tests as suggested by the physical examination are often helpful in ruling out general medical conditions that may produce depressive symptoms. In addition, the mental health professional should obtain information about the following:

  • Risk factors for suicidal or homicidal actions - Ie, age, sex, stressors, comorbid conditions, hopelessness, impulsivity
  • Protective factors for suicidal or homicidal actions - Eg, religious belief, concern about hurting family
  • Comorbid psychiatric diagnoses
  • Psychosocial problems
  • Academic problems
  • Recent and historical negative life events
  • Family psychiatric history and presence of family psychopathology
  • level of social support
  • Medical history
  • Current and past use of medications
  • Substance use

In addition, an assessment of global functioning will be useful in determining current impairment, if any, in life tasks.

Interview schedules

The Child Assessment Schedule (CAS), administered by a trained clinician, reliably and validly assesses PDD, as does the Interview Schedule for Children (ISC). Another widely used research scale, the Schedule for Affective Disorders and Schizophrenia in School-Age Children (K-SADS), does not assess dysthymia as a separate diagnostic category. Other structured interview schedules for use with lay interviewers do not differentiate PDD from generalized depression.

Self-report scales

Self-report measurement scales, such as the Children's Depression Inventory (developed from the Beck Depression Inventory) and the Reynolds Child and the Reynolds Adolescent depression scales, can be very helpful as screening tools. Moreover, when used as repeated measures, they have the advantage of also providing a means of assessing treatment response.

Indications of depression on self-report scales should be followed with a more thorough assessment by a physician or mental health professional. Multiple informants and multiple methods (eg, self-report, interview, observations) provide the most thorough picture of the extent of depression and of the level of functional impairment.

DesTeen

The Depression Screener for Teenagers (DesTeen) can be regarded as a valid screening tool for adolescent depression. It includes a self assessment and a diagnostic interview. The results of a shortened, 5-item version are particularly promising. [7]

Previous